"LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study"

作者全名："Wang, Dingyi; Fan, Guohui; Lei, Jieping; Yang, Yuanhua; Xu, Xiaomao; Ji, Yingqun; Yi, Qun; Chen, Hong; Hu, Xiaoyun; Liu, Zhihong; Mao, Yimin; Zhang, Jie; Shi, Juhong; Zhang, Zhu; Wu, Sinan; Tao, Xincao; Xie, Wanmu; Wan, Jun; Zhang, Yunxia; Zhang, Shuai; Zhen, Kaiyuan; Zhang, Zhonghe; Fang, Baomin; Wang, Chen; Zhai, Zhenguo"

作者地址："[Wang, Dingyi; Fan, Guohui; Lei, Jieping; Wu, Sinan] China Japan Friendship Hosp, Natl Ctr Resp Med, Inst Clin Med Sci, Beijing, Peoples R China; [Wang, Dingyi; Fan, Guohui; Lei, Jieping; Zhang, Zhu; Wu, Sinan; Tao, Xincao; Xie, Wanmu; Zhang, Yunxia; Zhang, Shuai; Zhen, Kaiyuan; Wang, Chen; Zhai, Zhenguo] Chinese Acad Med Sci, Inst Resp Med, Beijing, Peoples R China; [Yang, Yuanhua] Capital Med Univ, Beijing Chao Yang Hosp, Dept Pulm & Crit Care Med, Beijing, Peoples R China; [Xu, Xiaomao] Beijing Hosp, Natl Ctr Gerontol, Dept Pulm & Crit Care Med, Beijing, Peoples R China; [Xu, Xiaomao; Fang, Baomin] Chinese Acad Med Sci, Inst Geriatr Med, Beijing, Peoples R China; [Ji, Yingqun] Tongji Univ, East Hosp, Dept Pulm & Crit Care Med, Sch Med, Shanghai, Peoples R China; [Yi, Qun] Sichuan Univ, Dept Pulm & Crit Care Med, West China Hosp, Chengdu, Peoples R China; [Chen, Hong] Chongqing Med Univ, Dept Pulm & Crit Care Med, Affiliated Hosp 1, Chongqing, Peoples R China; [Hu, Xiaoyun] Shanxi Med Univ, Hosp 1, Taiyuan, Peoples R China; [Liu, Zhihong] Chinese Acad Med Sci & Peking Union Med Coll, Fuwai Hosp, Natl Ctr Cardiovasc Dis, Dept Cardiol, Beijing, Peoples R China; [Mao, Yimin] Henan Univ Sci & Technol, Dept Pulm & Crit Care Med, Affiliated Hosp 1, Luoyang, Peoples R China; [Zhang, Jie] Jilin Univ, Hosp 2, Dept Pulm Crit Care Med, Changchun, Jilin, Peoples R China; [Shi, Juhong] Peking Union Med Coll Hosp, Dept Pulm & Crit Care Med, Beijing, Peoples R China; [Zhang, Zhu; Tao, Xincao; Xie, Wanmu; Zhang, Yunxia; Zhang, Shuai; Zhen, Kaiyuan; Wang, Chen; Zhai, Zhenguo] China Japan Friendship Hosp, Ctr Resp Med, Dept Pulm & Crit Care Med, Beijing, Peoples R China; [Zhang, Zhu; Tao, Xincao; Xie, Wanmu; Zhang, Yunxia; Zhang, Shuai; Zhen, Kaiyuan; Wang, Chen; Zhai, Zhenguo] Natl Ctr Resp Med, Beijing, Peoples R China; [Wan, Jun] Capital Med Univ, Beijing Anzhen Hosp, Dept Pulm & Crit Care Med, Beijing, Peoples R China; [Zhang, Zhonghe; Fang, Baomin] Dalian Med Univ, Dept Pulm & Crit Care Med, Affiliated Hosp 1, Dalian, Peoples R China; [Wang, Chen] Natl Clin Res Ctr Resp Dis, Beijing, Peoples R China; [Wang, Chen] Chinese Acad Med Sci, Peking Union Med Coll, Beijing, Peoples R China; [Wang, Chen] Capital Med Univ, Dept Resp Med, Beijing, Peoples R China"

通信作者："Wang, C; Zhai, ZG (通讯作者)，Chinese Acad Med Sci, Inst Resp Med, Beijing, Peoples R China.; Wang, C; Zhai, ZG (通讯作者)，China Japan Friendship Hosp, Ctr Resp Med, Dept Pulm & Crit Care Med, Beijing, Peoples R China.; Wang, C; Zhai, ZG (通讯作者)，Natl Ctr Resp Med, Beijing, Peoples R China.; Wang, C (通讯作者)，Natl Clin Res Ctr Resp Dis, Beijing, Peoples R China.; Wang, C (通讯作者)，Chinese Acad Med Sci, Peking Union Med Coll, Beijing, Peoples R China.; Wang, C (通讯作者)，Capital Med Univ, Dept Resp Med, Beijing, Peoples R China."

来源：THROMBOSIS JOURNAL

ESI学科分类：　

WOS号：WOS:000791286600001

JCR分区：Q2

影响因子：3.1

年份：2022

卷号：20

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Acute pulmonary embolism; Renal insufficiency; Low molecular weight heparin; Adjusted dosage; Prognoses

摘要："Background: Renal function is associated with prognoses for acute pulmonary embolism (PE). Objective: To investigate the application of anticoagulants and dosage of LMWH among patients with renal insufficiency (RI), and the association between LWMH dosage and the patients' in-hospital outcomes. Methods: Adult patients diagnosed with non-high risk acute PE from 2009 to 2015, with available data of creatinine clearance (CCr) were enrolled from a multicenter registry in China. Renal insufficiency (RI) was defined as CCr <60 ml/min. LMWH dosage was converted into IU/kg daily dose and presented as adjusted dose (<= 100 IU/kg/day) and conventional dose (>100 IU/kg/day). All-cause death, PE-related death and bleeding events during hospitalization were analyzed as endpoints. Results: Among the enrolled 5870 patients, RI occurred in 1311 (22.3%). 30 <= CCr < 60 ml/min was associated with higher rate of bleeding events and CCr < 30 ml/min was associated with all-cause death, PE-related death and major bleeding. Adjusted-dose LMWH was applied in 26.1% of patients with 30 <= CCr < 60 ml/min and in 26.2% of CCr < 30 ml/min patients. Among patients with RI, in-hospital bleeding occurred more frequently in those who were administered conventional dose of LMWH, compared with adjusted dose (9.2% vs 5.0%, p = 0.047). Adjusted dose of LMWH presented as protective factor for in-hospital bleeding (OR 0.62, 95%CI 0.27-1.00, p = 0.0496) and the risk of bleeding increased as length of hospital stay prolonged (OR 1.03, 95%CI 1.01-1.06, p = 0.0014). Conclusions: The proportion of adjusted usage of LMWH was low. The application of adjusted-dose LMWH was associated with lower risk of in-hospital bleeding for RI patients, in real-world setting of PE treatment. Anticoagulation strategy for RI patients should be paid more attention and requires evidence of high quality."

基金机构："Fund of The National Key R&D Program of China [2018YFC1315100, 2016YFC0905600]; China Key Research Projects of the 11th National Five-Year Development Plan [2006BAI01A06]; China Key Research Projects of the 12th National Five-Year Development Plan [2011BA11B17]; CAMS Innovation Fund for Medical Sciences (CIFMS) [2018-I2M-1-003]; China-Japan Friendship Hospital Grant [2019-2-QN-78]"

基金资助正文："The study was funded by the Fund of The National Key R&D Program of China (No. 2018YFC1315100, No. 2016YFC0905600), the China Key Research Projects of the 11th National Five-Year Development Plan (No. 2006BAI01A06), the China Key Research Projects of the 12th National Five-Year Development Plan (No. 2011BA11B17) and the CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2018-I2M-1-003). China-Japan Friendship Hospital Grant (2019-2-QN-78)."